VSD灌洗引流联合抗生素骨水泥链珠植入治疗慢性骨髓炎

VSD Continuous Perfusion Combined with Antibiotic-PMMA Beads Implantation for Treatment of Chronic Osteomyelitis

目的探讨应用负压封闭引流技术（vacuumsealingdrainage，VSD）灌洗引流联合万古霉素骨水泥链珠植入治疗慢性骨髓炎的临床疗效。方法回顾性分析37例慢性骨髓炎患者经VSD灌洗引流联合抗生素骨水泥链珠植入治疗的临床效果，其中骨折术后感染31例，外伤后骨髓炎4例，无明显诱因出现的慢性骨髓炎2例。有内固定物的病例予以拆除原内固定，所有病例清创后应用VSD灌洗引流2周后，置人万古霉素骨水泥，6个月后待感染控制后，二期取出万古霉素骨水泥，混合植骨。结果本组患者术后全部得到随访，平均随访时间14．3（10～24）个月。其中35例经VSD灌洗引流、清创置入万古霉素骨水泥，患者感染获得控制，平均疗程3．4（3～6）个月。2例感染未控制，经再次清创、持续VSD灌洗引流后，感染得到控制。所有患者临床痊愈34例，基本痊愈1例，愈合差2例，治愈的患者在随访期间无复发。结论采用彻底清创、持续VSD灌洗引流、置入万古霉素骨水泥链珠的方法可有效控制感染，是较好的治疗慢性骨髓炎的方法。

Objective To explore the ettectiveness of vacuum sealing drainage （VSD） combined with antibiotic-PMMA beads implantation for the treatment of chronic osteomyelitis. Methods Retrospective anal- ysis was carried out in 37 cases with chronic osteomyelitis treated by VSD combined with antibiotie-PMMA beads. There were 31 cases of postoperative infection, 4 cases of traumatic osteomyelitis, and 2 cases had no apparent inducement. During operation, after removal of the original internal fixators and debridement, all the patients were treated with VSD. Two weeks later, the antibiotic-PMMA beads were implanted. And the antibiot- ie-PMMA beads were removed after six months, and a mixed bone graft was inputted after the infection was e- liminated. Results All patients were followed up for 10 ~ 24 months, with an average of 14.3 months. The infection was eliminated for 3 - 6 months in 35 cases. In the two patients of uncontrolled osteomyelitis, the un- controlled infection was debrided and the continuous VSD lavage was used again. There were 34 cases got clini- cal cured, 2 cases got basal cured and 1 case was worse. All the cured patients had not relapsed during the fol- low-up. Conclusion The method of thorough debridement, continuous VSD lavage, and antibiotic-PMMA beads implantation is an effective and ideal way to treat chronic osteomyelitis.